Abstract
Introduction
A common error in the initial operative management of patients with cloacal exstrophy is to create an ileostomy leaving the colon defunctionalized and connected to the urinary tract. These patients benefit from a “rescue operation” to give them the best opportunity to be future pull-through candidates.
Methods
Nineteen patients were identified who underwent an inadequate diversion during the newborn period, leaving a distal defunctionalized colon, and required a “rescue operation”. A retrospective review of the medical records of these patients was performed.
Results
A piece of colon was disconnected from the urinary tract, rescued from the pelvis, and incorporated into the fecal stream. The original stoma was closed, and an end colostomy was created. Fifteen patients were females and four were males. The length of rescued colon ranged from 5.5 to 20 cm. Symptoms present before the operation included: hyperchloremic acidosis (6), urinary tract infections (6), failure to thrive (5), sepsis (1), dehydration (1), and TPN dependent (1). There was resolution of these symptoms post-operatively. On follow up, 10 patients still have their colostomies as we are waiting for continued colonic growth, 6 patients had a pull-through after responding to our bowel management program through the stoma, 2 patients have a permanent stoma, and one patient expired.
Conclusion
When patients with cloacal exstrophy, or its variants, receive an ileostomy or proximal colostomy at birth, a rescue operation should be attempted.
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References
Rickham PP (1960) Vesico-intestinal fissure. Arch Dis Child 35:97–102
Phillips TM (2011) Spectrum of cloacal exstrophy. Semin Pediatr Surg 20:113–118
Mathews R, Jeffs RD, Reiner WG et al (1998) Cloacal exstrophy—improving the quality of life: the Johns Hopkins experience. J Urol 160:2452–2456
Soffer SZ, Rosen NG, Hong AR et al (2000) Cloacal exstrophy: a unified management plan. J Pediatr Surg 35:932–937
Sawaya D, Goldstein S, Seetharamaiah R et al (2010) Gastrointestinal ramifications of the cloacal exstrophy complex: a 44 year experience. J Pediatr Surg 45:171–176
Lund DP, Hendren WH (2001) Cloacal exstrophy: a 25-year experience with 50 cases. J Pediatr Surg 36:68–75
Bischoff A, Levitt M, Bauer C et al (2009) Treatment of fecal incontinence with a comprehensive bowel management program. J Pediatr Surg 44:1278–1283
Bischoff A, Levitt MA, Peña A (2009) Bowel management for the treatment of pediatric fecal incontinence. Pediatr Surg Int 25:1027–1042
Bischoff A, Tovilla M (2010) A practical approach to the management of pediatric fecal incontinence. Semin Pediatr Surg 19:154–159
Husmann DA, McLorie GA, Churchill BM et al (1988) Management of the hindgut in cloacal exstrophy: terminal ileostomy versus colostomy. J Pediatr Surg 23:1107–1113
McHoney M, Ransley PG, Duffy P et al (2004) Cloacal exstrophy: morbidity associated with abnormalities of the gastrointestinal tract and spine. J Pediatr Surg 39:1209–1213
Levitt MA, Mak GZ, Falcone RA et al (2008) Cloacal exstrophy—pullthrough or permanent stoma? a review of 53 patients. J Pediatr Surg 43:164–170
Mathews R (2011) Achieving urinary continence in cloacal exstrophy. Semin Pediatr Surg 20:126–129
Rangel SJ, Lawal TA, Bischoff A et al (2001) The appendix as a conduit for antegrade continence enemas in patients with anorectal malformations: lessons learned from 163 cases treated over 18 years. J Pediatr Surg 46:1236–1242
Chatoorgoon K, Peña A, Lawal T et al (2011) Neoappendicostomy in the management of pediatric fecal incontinence. J Pediatr Surg 46:1243–1249
Howell C, Caldamone A, Snyder H et al (1983) Optimal management of cloacal exstrophy. J Pediatr Surg 18:365–369
Taghizadeh A, Qteishat A, Cuckow PM (2009) Restoring hindgut continuity in cloacal exstrophy: a valuable method of optimizing bowel length. Eur J Pediatr Surg 19:141–144
Davidoff AM, Hebra A, Balmer D et al (1996) Management of the gastrointestinal tract and nutrition in patients with cloacal exstrophy. J Pediatr Surg 31:771–773
Stolar CJH, Randolph JG, Flanigan LP (1990) Cloacal exstrophy: individualized management through a staged surgical approach. J Pediatr Surg 25:505–507
Ricketts RR, Woodard JR, Zwiren GT et al (1991) Modern treatment of cloacal exstrophy. J Pediatr Surg 26:444–450
Bischoff A, Levitt MA, Breech L et al (2013) Covered cloacal exstrophy—a poorly recognized condition: hints for a correct diagnosis. J Pediatr Surg 48:2389–2392
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Bischoff, A., Brisighelli, G., Levitt, M.A. et al. The “rescue operation” for patients with cloacal exstrophy and its variants. Pediatr Surg Int 30, 723–727 (2014). https://doi.org/10.1007/s00383-014-3512-z
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DOI: https://doi.org/10.1007/s00383-014-3512-z